Filing Number: 793800
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| Filing Accepted: 11/22/2024 |
| Last/Business Name
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SIMES
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First Name |
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JEFFREY AND SHARON |
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| Street Address
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9192 ACORD BLVD |
| City, State Zip
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PUNTA GORDA,
FL
33982
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| Email Address
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TROGERS@WITESLAW.COM |
| Complainant Type:
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Insured |
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| Last/Business Name* |
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SIMES |
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First Name |
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JEFFREY AND SHARON |
| Policy # * |
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59-G2-0178-7 |
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Claim #* |
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59-39W5-78X |
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Attorney is Applicable
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| Last Name* |
ROGERS
First Name *
THOMAS
Initial
B
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| Street Address* |
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4400 N FEDERAL HIGHWAY |
| City, State Zip* |
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LIGHTHOUSE POINT
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FLORIDA
33604
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| Email Address * |
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TROGERS@WITESLAW.COM |
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| Insurer Type
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 Authorized Insurer
 Unauthorized Insurer
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| Insurer Name |
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| Insurer Name* |
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STATE FARM FLORIDA INSURANCE COMPANY
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| Insurer Name* |
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| Street Address* |
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| City, State Zip* |
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,
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NAIC Company Code 10739 |
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| Name of individual responsible for violation (if any):*
SAMUEL NORWOOD, AARON MCWILLIAMS
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| Type of Insurance
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Residential Property & Casualty
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| Reason for Notice
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Claim Delay
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Unsatisfactory Settlement Offer
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Unfair Trade Practice
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Claim Denial
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Statutory provision(s) which the insurer allegedly violated.
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| 624.155(1)(b)(1) |
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Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
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| 626.9541(1)(i)(2) |
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A material misrepresentation made to an insured or any other person having an interest in the proceeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damage under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy.
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| 626.9541(1)(i)(3)(a) |
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Failing to adopt and implement standards for the proper investigation of claims.
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| 626.9541(1)(i)(3)(b) |
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Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
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| 626.9541(1)(i)(3)(c) |
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Failing to acknowledge and act promptly upon communications with respect to claims.
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| 626.9541(1)(i)(3)(d) |
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Denying claims without conducting reasonable investigations based upon available information.
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| 626.9541(1)(i)(3)(e) |
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Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
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| 626.9541(1)(i)(3)(f) |
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Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
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Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
AGREEMENT
We agree to provide the insurance described in this policy:
1. based on your payment of premium, in a form acceptable
to us, for the coverages you chose;
2 based on your compliance with all applicable provisions
of this policy; and
3. based on the information you have given us and
your statements in this agreement.
You agree, by acceptance of this policy, that:
1. you will pay premiums when due and comply with the
provisions of this g You and we do not waive any rights by demanding
or submitting to an appraisal, and retain all
contractual rights to determine if coverage applies
to each item in dispute.
h. Appraisal is only available to determine the
amount of the loss of each item in dispute. The
appraisers and the umpire have no authority to
decide:
(1) any other questions of fact;
(2) questions of law;
(3) questions of coverage;
(4) other contractual issues; or
(5) to conduct appraisal on a class-wide basis.
i. Appraisal is a non-judicial proceeding and does
not provide for or require arbitration. Neither
party will be awarded attorney fees. The appraisal
award may not be entered as a judgment
in a court.
j. A party may not demand appraisal after that
party brings suit or action against the other party
relating to the amount of loss.
2. the statements in this agreement are your statements
and are true;
3. we insure you on the basis your statements are true;
and
4. this policy contains all of the agreements between
you and us and any of our agents.
When the information or factors used to calculate the premium
for this policy changes during the policy period as a
result of a change made by you, we may adjust the premium
in accordance with the change during the policy period
and you must pay any additional premium due within
the lime we specify. We will not adjust the premium during
the policy period for rate level or rating pan changes that
we have implemented.
SECTION I - PROPERTY COVERAGES
COVERAGE A- DWELLING
1.
Dwelling. We cover the dwelling and materials and
supplies located on or adjacent to the residence
premises for use in the construction, alteration, or repair
of the dwelling or other structures on the residence
premises.
2.
Other Structures. We cover other structures on the
residence premises, separated from the dwelling
by clear space. Structures connected to the dwelling
by only a fence, utility line, or similar connection
are considered to be other structures.
COVERAGE B- PERSONAL PROPERTY
1. Property Covered.
a. We cover personal property owned or used by an
insured while it is anywhere in the world. This includes
structures not permanently attached to or
otherwise forming a part of the realty. At your
request, we will cover personal property:
(1) owned by others while the property is on
the part of the residence premises occupied
exclusively by an insured;
(2) owned by a guest or a residence employee,
while the property is in any other
residence occupied by an insured; and
(3) owned by roomers, boarders, tenants, and
other residents, any of whom are related to
you.
COVERAGE C - LOSS OF USE
The most we will pay for the sum of all losses combined
under Additional Living Expense, Fair Rental Value,
and Prohibited Use is the limit of liability shown in the
Declarations for Coverage C - Loss of Use.
1. Additional Living Expense. When a loss caused by
a peril described in SECTION I - LOSSES INSURED
causes the residence premises to become uninhabitable,
we will pay the reasonable and necessary increase
in cost incurred by an insured to maintain
their normal standard of living for up to 24 months.
Our payment is limited to incurred costs for the shortest
of:
a. the time required to repair or rep ace the premises;
b. the time required for your household to settle
elsewhere; or
c. 24 months.
This period of lime is not limited by the expiration of
this policy.
SECTION I - LOSSES INSURED
COVERAGE A- DWELLING
We will pay for accidental direct physical loss to the property
described in Coverage A, unless the loss is excluded
or limited in SECTION I-LOSSES NOT INSURED or otherwise
excluded or limited in this policy. However, loss
does not include and we will not pay for, any diminution
in value.
COVERAGE 8- PERSONAL PROPERTY
We will pay for accidental direct physical loss to the property
described in Coverage B caused by the following perils, unless
the loss is excluded or limited in SECTION I- LOSSES
NOT INSURED or otherwise excluded or limited in this policy.
However, loss does not include and we will not pay
for, any diminution in value.
2. Windstorm or hail. This peril does not include loss
to property contained in a structure caused by rain,
snow, sleet, sand, or dust. This limitation does not
apply when the direct force of wind or hail damages
the structure causing an opening in a roof or wall and
the rain, snow, sleet, sand, or dust enters through this
opening.
This peril includes loss to watercraft of all types and
their trailers, furnishings, equipment, and outboard
motors, only while inside a building structure.
SECTION I - LOSS SETTLEMENT
Only the Loss Settlement Provisions shown in the Declarations
apply. We will settle covered property losses
according to the following. However, the valuation of any
covered property losses does not include, and we will not
pay, any amount for diminution in value.
COVERAGE A- DWELLING
1. A1 - Replacement Cost Loss Settlement- Similar
Construction.
a. We will pay the cost to repair or replace with similar
construction and for the same use on the
premises shown in the Declarations, the damaged
part of the property covered under SECTION
I - PROPERTY COVERAGES,
COVERAGE A- DWELLING, except for wood
fences, subject to the following
(1) we will pay only the actual cash value at
the lime of the loss prior to repair or replacement
of the damaged part of the property,
up to the applicable limit of liability
shown in the Declarations, not to exceed
the cost to repair or replace the damaged
part of the property;
(2) in addition, we will pay any remaining covered
additional amounts you actually and
necessarily incur to perform such repair or
replacement as work is performed and expenses
are incurred and submitted, or an
amount up to the applicable limit of liability
shown in the Declarations, whichever
is less. There will be no deduction for depreciation;
(3) we will not pay for increased costs resulting
from enforcement of any ordinance or law
regulating the construction, repair or demolition
of a building or other structure, except
as provided under OPTIONAL
POLICY PROVISIONS, Option OL -
Building Ordinance or Law Coverage;
and (4) if a total loss occurs to the dwelling used
principally as a private residence on a residence
premises shown in the Declarations,
payment on a replacement cost
basis will not require repair or replacement
of the damaged property. There will be no
deduction for depreciation
2. A2 - Replacement Cost Loss Settlement - Common
Construction.
a. We will pay the cost to repair or replace with
common construction and for the same use on
the premises shown in the Declarations, the
damaged part of the property covered under
SECTION I-PROPERTY COVERAGES, COVERAGE
A - DWELLING, except for wood
fences, subject to the following:
(1) we will pay only for repair or replacement
of the damaged part of the property with
common construction techniques and materials
commonly used by the building
trades in standard new construction. We
will not pay the cost to repair or rep ace obsolete,
antique, or custom construction with
like kind and quality;
(2) we will pay only the actual cash value at
the time of the loss prior to repair or replacement
of the damaged part of the property,
up to the applicable limit of liability
shown in the Declarations, not to exceed
the cost to repair or replace the damaged
part of the property as described in a.(1)
above;
(3) in addition, we will pay any remaining covered
additional amounts you actually and
necessarily incur to perform such repair or
replacement, as described in a.(1) above,
as work is performed and expenses are incurred
and submitted, or an amount up to
the applicable limit of liability shown in the
Declarations, whichever is less. There will
be no deduction for depreciation; (4) we will not pay for increased costs resulting
from enforcement of any ordinance or law
regulating the construction, repair or demolition
of a building or other structure, except
as provided under OPTIONAL
POLICY PROVISIONS, Option OL -
Building Ordinance or Law Coverage;
and
(5) if a total loss occurs to the dwelling used
principally as a private residence on a residence
premises shown in the Declarations,
payment as described in a.(1)
above, will not require repair or replacement
of the damaged property. There will
be no deduction for depreciation.
COVERAGE 8- PERSONAL PROPERTY
1. 81 - Limited Replacement Cost Loss Settlement.
a. We will pay the cost to repair or rep ace property
covered under SECTION I - PROPERTY COVERAGES,
COVERAGE B - PERSONAL
PROPERTY without deduction for depreciation
and whether or not you replace the property, except
for property listed in item b. below.
b. We will pay market value at the time of loss for:
(1) antiques, fine arts, paintings, statuary, and
similar articles which by their inherent nature
cannot be replaced with new articles;
(2) articles whose age or history contribute substantially
to their value including, but not
limited to, memorabilia, souvenirs, and collectors
items;
(3) property not useful for its intended purpose.
SECTION I - CONDITIONS
Appraisal. If you and we fail to agree on the amount
of any loss under SECTION I- PROPERTY COVERAGES,
either party can demand that the amount of
the loss be set by appraisal. A demand for appraisal
must be in writing. You must comply with SECTION
I - CONDITIONS, Your Duties After Loss before
making a demand for appraisal. At least 10 days before
demanding appraisal, the party seeking appraisal
must provide the other party with written, itemized
documentation of a specific dispute as to the amount
of the loss, identifying separately each item being disputed.
a. Each party will select a competent, disinterested
appraiser and notify the other party of the appraiser's
identity within 20 days of receipt of the
written demand for appraisal.
b. The appraisers will then attempt to set the
amount of the loss of each item in dispute as
specified by each party, and jointly submit to
each party a written report of agreement signed
by them. In all instances the written report of
agreement will be itemized and state separately
the actual cash value, replacement cost, and if
applicable, the market value of each item in dispute.
The written report of agreement will set the
amount of the loss of each item in dispute and
will be binding upon you and us.
c. If the two appraisers fail lo agree upon the
amount of the loss within 30 days, unless the period
of ti me is extended by mutual agreement, they
will select a competent, disinterested umpire and
will submit their differences to the umpire. If the
appraisers are unable to agree upon an umpire
within 15 days
(1) you or we may make a written application
for a judge of a court of record in the same
state and county (or city if the city is not
within a county) where the residence
premises is located to select an umpire;
(2) the party requesting the selection described
in item c. ( 1) must provide the other party
(a) written notice of the intent to file,
identifying the specific location and
identity of the court at I east 10 days
prior to submission of the written application;
and
(b) a copy of the written application; and
(3) a written report of agreement, as required
in item b., signed by any two (appraisers or
appraiser and umpire) will set the amount
of the loss of each item in dispute and will
be binding upon you and us. In all instances
the written report of agreement will
be itemized and state separately the actual
cash value, replacement cost, and if applicable,
the market value of each item in dispute.
d. To qualify as an appraiser or umpire for a loss to
property described in COVERAGE A- DWELLING,
a person must be one of the following and
be licensed or certified as required by the applicable
jurisdiction:
(1) an engineer or architect with experience
and training in building construction, repair,
estimating, or investigation of the type of
property damage in dispute;
(2) an adjuster or public adjuster with experience
and training in estimating the type of
property damage in dispute; or
(3) a contractor with experience and training in
the construction, repair, and estimating of
the type of property damage in dispute.
e. A person may not serve as an appraiser or umpire
if that person, any employee of that person,
that person's employer, or any employee of their
employer has:
(1) a familial relationship within the third degree
between the umpire or appraiser and
a party or a representative of a party;
(2) previously represented a party in a professional
capacity in the same claim or matter
involving the same property;
(3) represented another person in a professional
capacity on the same or a substantially
related matter that includes the claim,
the same property or an adjacent property,
and the other person's interests are materially
adverse to the interests of a party;
(4) worked as an employer or employee of a
party within the preceding 5 years; or
(5) a financial interest in the outcome of the
claim at issue in the appraisal.
f. Each party will be responsible for the compensation
of their selected appraiser. Reasonable
expenses of the appraisal and the reasonable
compensation of the umpire will be paid equally
by you and us.
g You and we do not waive any rights by demanding
or submitting to an appraisal, and retain all
contractual rights to determine if coverage applies
to each item in dispute.
h. Appraisal is only available to determine the
amount of the loss of each item in dispute. The
appraisers and the umpire have no authority to
decide:
(1) any other questions of fact;
(2) questions of law;
(3) questions of coverage;
(4) other contractual issues; or
(5) to conduct appraisal on a dass-wide basis.
i. Appraisal is a non-judicial proceeding and does
not provide for or require arbitration. Neither
party will be awarded attorney fees. The appraisal
award may not be entered as a judgment
in a court.
j. A party may not demand appraisal after that
party brings suit or action against the other party
relating to the amount of loss.
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Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.
Jeffrey and Sharon Simes (“Claimants”) are the owner of the property located at 9192 Acord Blvd, Punta Gorda Florida 33982 (the “Property”). The Claimants purchased a residential property and casualty insurance policy (the “Policy”) from State Farm Florida Insurance Company (“Insurer”) bearing Policy Number 59-G2-0178-7 providing coverage from February 1, 2022 through February 1, 2023. At all times material hereto, the Policy provided coverage for the Property owned by the Claimants.
On or about September 28, 2022 Claimants sustained damage to the Property as a result of Hurricane Ian, including but not limited to damages to the roof, exterior, and interior of the Property (the “Loss”). Claimants provided notice of the loss to Insurer and it assigned claim number HO-3043181 (the “Claim”). The damage to Claimant’s Property was caused by a hurricane which is covered under the terms and conditions of the Policy.
Claimant timely reported the claim to Insurer. The initial inspection of Claimant’s Property took place on October 15, 2022, and was conducted by Field Adjuster LaTandra Harrison. Ms. Harrison provided a payment letter, a damages estimate in the amount of $58,076.89, and a check in the amount of $27,598.10. Unsatisfied with the inadequate damages estimate and payment, Claimants retained Safeguard Public Adjusters on September 13, 2023 to assist them with the Claim so they could be fully indemnified for their covered loss. Safeguard Public Adjusters then conducted their own inspection of the Property and provided a competing damages estimate to State Farm, a Sword Proof of Loss, and supporting documentation to State Farm in the amount of $422,929.17.
State Farm did not respond to Safeguard's communications or demand. Therefore, Safeguard demanded mediation with the Department of Financial Services. On July 23, 2024, mediation impassed. On August 7, 2024, State Farm reinspected the Property and informed Safeguard that it was standing by its prior adjustment of the claim and valuation of Claimant's damages, and would offer no additional money. Safeguard then invoked appraisal, and named Cristina Afonso as their appraiser. State Farm named Aaron McWilliams as its appraiser.
State Farm participated in appraisal and then on October 24, 2024 provided Mr. McWilliams' appraisal estimate in the amount of $97,083.46, nearly double that of its initial estimate, despite conducting two separate field inspections of the Property, by two different field adjusters. State Farm's appraiser severely undervalued the damages and refused to apply coverage or valuations for damages at the Property that were previously extended by State Farm's field adjusters. State Farm is interfering with the appraisal process by instructing its appraiser to undervalue the claim.
Insurer has significantly underpaid Claimant for damages to the Property and has failed to comply with the following statutes:
624.155(1)(b)(1) - State Farm failed to properly indemnity Claimants for their loss.
626.9541(1)(i)(2) - State Farm's insurance adjuster allowed for repair of 12 windows on Claimant's Property and made payment for the windows. Then State Farm's appraiser, presumably with direction from State Farm, refused to include any windows in his appraisal. Additionally, State Farm refused to consider or acknowledge a $6,525.00 estimate for replacement of a closed circuit TV monitoring system at Claimant's Property that was damaged in the Hurricane.
626.9541(1)(i)(3)(a) - The roof skylight was damaged and leaked during the Hurricane. Temporary repairs were made to mitigate the Loss. Claimant Jeffrey Simes suffers from a serious illness that necessitated immediate and through remediation of the water intrusion issue, however, State Farm refuses to consider his illness in its allowance for repairs and/or remediation of the issue.
626.9541(1)(i)(3)(b) - State Farm is assigning new, hurricane-related damages (wood flooring in living room resulting from chimney cap blowing off) to an old claim and old damage from a failed AC handler. This is a misrepresentation of facts and State Farm is fully aware of this misrepresentation.
626.9541(1)(i)(3)(c) - Safeguard requested a full and complete copy of the Policy on September 19, 2023. State Farm failed to provide same until almost two months later on November 17, 2023.
626.9541(1)(i)(3)(d) - State Farm failed to retain a mold remediation company or expert, or structural engineer, to adequately investigate the Loss.
626.9541(1)(i)(3)(e) - State Farm failed to acknowledge or reject Claimants' Sworn Proof of Loss.
626.9541(1)(i)(3)(f) - Claimants provided receipts for some of the repairs which were paid out of pocket. Carrier reimbursed for lesser amounts with no explanation as to why the full amount was not reimbursed.
Therefore, to cure the defects outlined in this Civil Remedy Notice, Insurer must:
(1) Create and implement adequate guidelines for proper investigation and evaluation as to claims handling and for the training and supervision of employees, which will avoid future statutory violation as set forth above to avoid this from occurring in the future,
(2) Immediately tender payment for the covered damages sustained to the Insured Property
(3) Agree to reimburse Insured’s reasonable attorneys fees and costs and public adjuster fees for having to become involved to resolve the claim.
COVERAGE C - LOSS OF USE
The most we will pay for the sum of all losses combined
under Additional Living Expense, Fair Rental Value,
and Prohibited Use is the limit of liability shown in the
Declarations for Coverage C - Loss of Use.
1. Additional Living Expense. When a loss caused by
a peril described in SECTION I - LOSSES INSURED
causes the residence premises to become uninhabitable,
we will pay the reasonable and necessary increase
in cost incurred by an insured to maintain
their normal standard of living for up to 24 months.
Our payment is limited to incurred costs for the shortest
of:
a. the time required to repair or rep ace the premises;
b. the lime required for your household to setue
elsewhere; or
c. 24 months.
This period of lime is not limited by the expiration of
this policy.
SECTION I - LOSSES INSURED
COVERAGE A- DWELLING
We will pay for accidental direct physical loss to the property
described in Coverage A, unless the loss is excluded
or limited in SECTION I-LOSSES NOT INSURED or otherwise
excluded or limited in this pdicy. However, loss
does not include and we will not pay for, any diminution
in value.
COVERAGE 8- PERSONAL PROPERTY
We will pay for accidental direct physical loss to the property
described in Coverage B caused by the following perils, unless
lhelossis excluded or limited in SECTION I- LOSSES
NOT INSURED or otherwise excluded orli mi led in this policy.
However, loss does not include and we will not pay
for, any diminution in value.
2. Windstorm or hail. This peril does not include loss
to property contained in a structure caused by rain,
snow, sleet, sand, or dust. This limitation does not
apply when the direct force of wind or hail damages
the structure causing an opening in a roof or wall and
the rain, snow, sleet, sand, or dust enters through this
opening.
This peril includes loss to watercraft of all types and
their trailers, furnishings, equipment, and outboard
motors, only while inside a building structure
SECTION I - LOSS SETTLEMENT
Only the Loss Settlement Provisions shown in the Declarations
appy. We will selfle covered property losses
according to the following. However, the valuation of any
covered property losses does not include, and we will not
pay, any amount for diminution in value.
COVERAGE A- DWELLING
1. A1 - Replacement Cost Loss Settlement- Similar
Construction.
a. We will pay the cost to repair or replace with similar
construction and for the same use on the
premises shown in the Declarations, the damaged
part of the property covered under SECTION
I - PROPERTY COVERAGES,
COVERAGE A- DWELLING, except for wood
fences, subject to the following
(1) we will pay only the actual cash value at
the lime of the loss prior to repair or replacement
of the damaged part of the property,
up to the appica~e limit of liability
shown in the Declarations, not to exceedthe cost to repair or replace the damaged
part of the property;
(2) in addition, we will pay any remaining covered
additional amounts you actually and
necessarily incur to perform such repair or
replacement as work is performed and expenses
are incurred and submitted, or an
amount up to the applicable limit of liability
shown in the Declarations, whichever
is less. There will be no deduction for depreciation;
2. A2 - Replacement Cost Loss Settlement - Common
Construction.
a. We will pay the cost to repair or replace with
common construction and for the same use on
the premises shown in the Declarations, the
damaged part of the property covered under
SECTION I-PROPERTY COVERAGES, COVERAGE
A - DWELLING, except for wood
fences, subject to the following:
(1) we will pay only for repair or repacement
of the damaged part of the property with
common construction techniques and materials
commonly used by the building
trades in standard new construction. We
will not pay the cost to repair or rep ace obsolete,
antique, or custom construction with
like kind and quality;
(2) we will pay only the actual cash value at
the time of the loss prior to repair or replacement
of the damaged part of the property,
up to the appicatfa limit of liability
shown in the Declarations, not to exceed
the cost to repair or replace the damaged
part of the property as described in a.(1)
above;
(3) in addition, we will pay any remaining covered
additional amounts you actually and
necessarily incur to perform such repair or
replacement, as described in a.(1) above,
as work is performed and expenses are incurred
and submitted, or an amount up to
the applicable limit of liability shown in the
Declarations, whichever is less. There will
be no deduction for depreciation;
COVERAGE 8- PERSONAL PROPERTY
1. 81 - Limited Replacement Cost Loss Settlement.
a. We will pay the cost to repair or rep ace property
covered under SECTION I - PROPERTY COVERAGES,
COVERAGE B - PERSONAL
PROPERTY without deduction for depreciation
and whether or not you replace the property, except
for property listed in item b. below.
b. We will pay market value at the time of loss for:
(1) antiques, fine arts, paintings, statuary, and
similar articles which by their inherent nature
cannot be replaced with new articles;
(2) artides whose age or history contribute substantially
to their value including, but not
limited to, memorabilia, souvenirs, and collectors
items; and
(3) property not useful for its intended purpose.
SECTION I - CONDITIONS
4. Appraisal. If you and we fail to agree on the amount
of any loss under SECTION I- PROPERTY COVERAGES,
either party can demand that the amount of
the loss be set by appraisal. A demand for appraisal
must be in writing. You must compy with SECTION
I - CONDITIONS, Your Duties After Loss before
making a demand for appraisal. At least 10 days before
demanding appraisal, the party seeking appraisal
must provide the other party with written, itemized
documentation of a specific dispute as to the amount
of the loss, identifying separately each item being disputed
a. Each party will select a competent, disinterested
appraiser and notify the other party of the appraiser's
identity within 20 days of receipt of the
written demand for appraisal.
b. The appraisers will then attempt to set the
amount of the loss of each item in dispute as
specified by each party, and jointly submit to
each party a written report of agreement signed
by them. In all instances the written report of
agreement will be itemized and state separately
the actual cash value, replacement cost, and if
applicable, the market value of each item in dispute.
The written report of agreement will set the
amount of the loss of each item in dispute and
will be binding upon you and us.
c. If the two appraisers fail lo agree upon the
amount of the loss within 30 days, unless the period
of ti me is extended by mutual agreement, they
will select a competent, disinterested umpire and
will submit their differences to the umpire. If the
appraisers are unable to agree upon an umpire
within 15 days
(1) you or we may make a written application
for a judge of a court of record in the same
state and county (or city if the city is not
wi thin a county) where the residence
premises is localed to select an umpire;
(2) the party requesting the selection described
in item c. ( 1) must provide the other party
(a) written notice of the intent to file,
identifying the specific location and
identity of the court at I east 10 days
prior to submission of the written application;
and
(b) a copy of the written application; and
(3) a written report of agreement, as required
in item b., signed by any two (appraisers or
appraiser and umpire) will set the amount
of the loss of each item in dispute and will
be binding upon you and us. In all instances
the written report of agreement will
be itemized and state separately the actual
cash value, replacement cost, and if appicable,
the market value of each item in dispute.
d. To qualify as an appraiser or umpire for a loss to
property described in COVERAGE A- DWELLING,
a person must be one of the following and
be licensed or certified as required by the applicable
jurisdiction:
(1) an engineer or architect with experience
and training in building construction, repair,
estimating, or investigation of the type of
property damage in dispute;
(2) an adjuster or public adjuster with experience
and training in estimating the type of
property damage in dispute; or
(3) a contractor with experience and training in
the construction, repair, and estimating of
the type of property damage in dispute.
e. A person may not serve as an appraiser or umpire
if that person, any empoyee of that person,
that person's employer, or any employee of their
g You and we do not waive any rights by demanding
or submitting to an appraisal, and retain all
contractual rights to determine if coverage applies
to each item in dispute.
h. Appraisal is only available to determine the
amount of the loss of each item in dispute. The
appraisers and the umpire have no authority to
decide:
(1) any other questions of fact;
(2) questions of law;
(3) questions of coverage;
(4) other contractual issues; or
(5) to conduct appraisal on a dass-wide basis.
i. Appraisal is a non-judicial proceeding and does
not provide for or require arbitration. Neither
party will be awarded attorney fees. The appraisal
award may not be entered as a judgment
in a court.
j. A party may not demand appraisal after that
party brings suit or action against the other party
relating to the amount of loss.
empoyer has:
(1) a familial relationship within the third degree
between the umpire or appraiser and
a party or a representative of a party;
(2) previously represented a party in a professional
capacity in the same claim or matter
involving the same property;
(3) represented another person in a professional
capacity on the same or a substantially
related matter that includes the claim,
the same property or an adjacent property,
and the other person's interests are materially
adverse to the interests of a party;
(4) worked as an employer or employee of a
party within the preceding 5 years; or
(5) a financial interest in the outcome of the
claim at issue in the appraisal.
f. Each party will be responsible for the compensation
of their selected appraiser. Reasonable
expenses of the appraisal and the reasonat)e
compensation of the umpire will be paid equally
by you and us.
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The submitter hereby states that this notice is given in order to perfect the rights of the
person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes.
Before submitting a Notice using this system, please verify that all text has been entered
correctly and completely. Once the Notice has been submitted, the text cannot be changed
or deleted.
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DFS-10-363
Rev. 10/14/2008
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